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Is a Cinderella service tolerable for 3 million over 80?

The Equality and Human Rights Commission report ‘Close to Home’, published today, makes sober reading. Recent reports have all shown unacceptably poor and sinking standards for vulnerable people in care – in hospitals (Mid Staffs), in residential care (Southern Cross, Winterbourne), and now in domicilary care in their own homes (this EHRC report based on interviews with 1,200 older people). Every time they are greeted with assurances that lessons have been learnt and mistakes will be corrected in future, or Ministerial puffs like Burstow yesterday:

I am determined to root out ageism and bad practice to drive up quality and dignity in care.

Really? So why do these reports of poor care or bad care (financial or physical abuse) keep on coming with monotonous regularity? Are we really concerned about the care of helpless old people or is it just a facade? What should really be done?

This is an area of policy where neglect and unconcern runs deep at all levels. It is being subjected to a bigger expenditure cut (£1.3bn in real terms in this 5 year parliamentary period) than most other areas, so that an already precarious provision will inevitably become a largely failed service by 2015. This is too in the face of remorselessly increasing need. There are 3 million people over 80 now; by 2030 it will nearly double and by 2050 nearly treble. If any service unequivocally needs more resources, more carers, more priority, this is surely it.

The payment system is a disaster. In the 1970s some 90% of social care for the elderly was undertaken by local authorities; as a result of privatisation under Thatcher in the 1980s the position is reversed – some 90% of care is provided by private care agencies, but still commissioned and paid by local authorities. As a result of the introduction of competition by price, standards are steadily eroding (despite genuine efforts by many care agencies to maintain and improve standards), even to the point of care visits being limited to 15 minutes, which is frankly absurd. Under pressure from the cuts, with no absolute floor in quality strictly enforced, this can only get worse, especially when so many care staff are paid at or only just above the minimum wage which works against stable and positive relationships with older people being cared for as well as leading to high staff turnover.

And the regulatory system is failing. The CQC (Care Quality Commission), led by Cynthia Bower (amazingly, since she was chief executive of the appallingly mismanaged Mid Staffs hospital), is under-resourced and has drastically cut back on inspections, and even those undertaken are not always unannounced. Nor are those cared for in their own homes covered by the Human Rights Act, though those in residential homes are.

These are the people, ours and your parents, who are going to pay a very heavy price, perhaps the heaviest, as a result of the cuts.

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